Diseases In Anamnesis Research Articles

The women of reproductive age have actual aspects of pathology of endometrium

The objective: optimization of tactic of conduct of women of reproductive age is after the delete of endometrial polyps on the basis of study of antioxidant status of organism and uterine blood flow.Materials and methods. 165 women of reproductive age took part in research. From them – 150 with endometrial polyps and 15 practically healthy women of reproductive age with regular ovulatory by a menstrual cycle, which did not have gynaecological diseases in anamnesis, and made a control group. The criteria of exception of patients from research were: malignant pathological process in the organs of the reproductive system or other localization, hormone-producing ovarian tumour, uterine fibroids and adenomyosis, and also pregnancy and lactation.A complex clinical-and-laboratory inspection which included a echographic inspection was conducted all women, Doppler, coloured Doppler mapping organs of small pelvis, hysteroscopy with the separate diagnostic scraping off of cervical canal and cavity of uterus, morphological research of remote polyps and determination of parameters of antioxidant status.Results. Ultrasonic research of organs of small pelvis in combination with coloured Doppler mapping and enables the curves of speeds of blood flow nono-invasive to estimate the change of indexes of blood flow to myo- endometrium in case of occurring of endometrial polyps. For patients with endometrial polyps as compared to the women of control group in the follicle phase of menstrual cycle for certain the low values of resistance index were determined only in radial and basale arteries (in radial arteries – 0,58±0,01 and 0,66±0,01, respectively; p<0,01; in basale arteries – 0,50±0,01 and 0,57±0,01, respectively; p<0,01). Reliable decline of vascular resistance for patients with endometrial polyps in radial and basale arteries and, respectively, vasodilatation of vessels of uterus, obviously, it can explain enhanceable maintenance of estrogen and estrogen receptors. From our data, in arcuate arteries at glandular polyps an arterial blood flow appeared in 93,8%, and at glandular-fibrotic polyps – in 61,2%, in radial arteries – 89,2% and 45,9% respectively, in basale arteries 81,5% and 35,3%, respectively. Research results rotined that stromal fibrosis mainly had met for patients which have glandular-fibrotic endometrial polyps. Leykocyte-histiocytic infiltration was characteristic to the glandular polyps, and lymphocytic infiltration – glandular-fibrotic to the endometrial polyps. Both glandular and glandular-fibrotic polyps were characterized by the thick-walled vessels. Vessels with the sclerosis of walls met only in glandular-fibrotic polyps in 17,4% cases. Found out by us considerable violations in antioxidant status for patients in the first days after operative interference as compared to analogical indexes for patients with the endometrial polyps to the operation conditioned by operating stress.Conclusions. For prognostication of possible risk of relapse of endometrial polyps after their operative delete it is suggested to conduct the Doppler monitoring with the use of method of coloured Doppler mapping in the basale and radial arteries of uterus in a postoperative period in a dynamics. With a purpose to normalization of antioxidant status is expedient and grounded in quality the mean of antirecurrent therapy to use the algorithm in methodology of which stopped up naturally evolutional the formed models developed by us, one of which there is co-operation of water-reducing and fatty components of the antioxidant system and, in particular, glutathione, ascorbic acid and tocopherol. Other natural model which an organism produced as a result of phylogenesis and protracted natural selection is a non-invasive electronic satiation of organism with the purpose of suppression freely radical to activity, neutralization and detoxication of tissue.A positive therapeutic effect is got after the algorithm which includes the complex use of antioxidant preparations (thioctic and ascorbic acid, alfa-tocopherol and indole-3-carbinol) in combination with the non-invasive satiation of tissue by electrons developed by us, can allow to revise some traditional going near treatment of hyperplastic processes of reproductive organs for women, that, no doubt, requires the modern methodological and methodical approaches scientifically grounded.Keyword: endometrial polyps, relapse, antioxidant status, uterine blood flow.

Periostin as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease

BACKGROUND: Asthma and chronic obstructive pulmonary disease are common chronic respiratory diseases. Given their heterogeneity, the study of periostin is a relevant area for establishing the endotypes of airway inflammation and determining further therapy tactics. AIM: To evaluate periostin levels and determine its significance as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease. MATERIALS AND METHODS: The study included 59 patients with asthma and 33 patients with chronic obstructive pulmonary disease. The control group consisted of 37 apparently healthy people, comparable in age and sex, without allergic and bronchial obstructive diseases in anamnesis. The anamnesis data, the number of peripheral blood eosinophils and induced sputum, indices of external respiratory function were evaluated. Levels of specific immunoglobulin E to allergens, periostin level were determined in blood serum by immunoenzyme method. The obtained data were processed using STATISTICA 13 and SPSS Statistic 27 software systems. RESULTS: The maximum serum periostin concentration 22.5 (17–38) ng/ml was recorded in the patients with asthma, which was significantly higher than in the chronic obstructive pulmonary disease group [16 (12–21) ng/ml; p = 0.006] and control group [20.1 (14.6–24.8) ng/ml; p = 0.044]. The level of periostin in induced sputum in the patients with asthma was significantly higher than in the chronic obstructive pulmonary disease group — 0.05 (0.03–0.6) ng/ml vs 0.03 (0.02–0.04) ng/ml (p = 0.008). The study revealed the correlation between serum periostin level and eosinophil level (r = 0.406; p 0.05) and with forced expiratory volume in the first second after bronchodilator test (r = 0.366; p 0.05) as well as with forced expiratory volume in the first second divided by forced vital capacity after bronchodilator test (r = 0.572; p 0.05). CONCLUSIONS: Periostin is a promising marker of eosinophilic inflammation in patients with asthma, which can be considered as an indicator of fixed bronchial obstruction and a molecule linking T2-inflammation and airway remodelling. In a group of chronic obstructive pulmonary disease patients, the use of periostin for diagnostic and prognostic purposes requires further investigation and larger studies.

Інфекційна еритема та феномен Рейно в дитини після перенесеної коронавірусної хвороби: опис клінічного випадку

Purpose - to analyze practice cases with an atypical course associated with comorbid pathology; to acquaint pediatricians and family physicians with the diagnostic search algorithm. The article summarizes literature data, and describes a clinical case of erythema infectiousum in combination with Raynaud's phenomenon, which occurred in a 9-year-old child І. with coronavirus disease in anamnesis. It was established that the nature of the pathological changes: periodic hyperemia of the cheeks and auricles, “slapped cheeks”, and, at the same time, palleness of the nasolabial triangle, a pronounced change in color, marbling of the skin on the limbs and on the buttocks, with a lacy pattern of vessels, which are provoked by exposure to cold air or psycho-emotional excitement, clearly indicate both the manifestations of parvovirus infection, and the Raynaud's phenomenon mentioned above. On the other hand, post-covid syndrome is also often accompanied by non-specific changes in the skin and its derivatives (up to 20.4% of cases) in the form of urticaria, erythema, and frostbite. In the same group of patients, there are maculopapular rashes and livedo reticularis, those could be Conclusions. During the pandemic of coronavirus infection, the issues of comorbid pathological conditions in pediatrics, which have a blurred clinical picture, an atypical course, common links of pathogenesis, in particular microcirculation disorders, and require an interdisciplinary approach to the management of these diseases, rehabilitation measures, are becoming more and more relevant. interpreted both as a manifestation of systemic vasculitis, and as independent disease. Thus, the patient was diagnosed with infectious erythema caused by parvovirus B19 in combination with Raynaud's phenomenon, probably caused by a history of coronavirus disease. The multicomponent nature of the patient's symptoms is highlighted, and the diagnostic search algorithm is shown. The study was conducted in accordance with the principles of the Declaration of Helsinki. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the authors.

Pharmacoepidemiological analysis of therapy for chronic heart failure

The aim of the study was to examine the schemes proposed in the clinical guidelines and to compare them with inpatient treatment methods.Materials and method, the case histories of 40 patients of cardiology department of Saratov medical preventive institution were analyzed. Men and women, aged from 50 to 80 years, with functional class (FC) II to IV, with reduced left ventricular ejection fraction (< 40 %) and with such diseases in anamnesis as arterial hypertension, coronary heart disease, atherosclerosis, diabetes mellitus were in the inclusion group. The exclusion group included patients with noncardiac diseases, pediatric patients, patients under 50 and over 80 years old, patients with I class, preserved and intermediate LV ejection fraction (> 40 %). The results of immunochromatographic analysis of NT-proBNP marker were studied, the identity of prescribed drugs to a certain group and their frequency of use, as well as the similarity of prescribed regimen to clinical guidelines were determined.Results. NT-proBNP level over 125 pg/ml was revealed in 21 out of 40 patients, arterial hypertension, atherosclerosis, ischemic heart disease were in the anamnesis testifying to high probability of CHF. Perindopril (80 %) and fosinopril (20 %) were the main angiotensin-converting enzyme inhibitors (ACEIs). Spironolactone (a К + -saving diuretic), thorasemide, furosemide (a loop diuretic) and indapamide (a thiazide-like diuretic) were used as diuretics. Among blockers, metoprolol (20 %), nebivolol (30 %), bisoprolol (50 %) were prescribed. Patients suffering from CHF and with a history of atherosclerosis were prescribed statins (rosuvastatin, atorvastatin) in addition to the main groups of drugs in all cases. Warfarin (9.5 %) and rivaroxaban (23.8 %) were present in 7 of 21 cases (33 %). In addition, 17 patients (81 %) were prescribed acetylsalicylic acid as an antiaggregant. Those with a history of diabetes mellitus (19 %) received metformin for glycaemic control, as an adjunctive therapy to the main combinations of drugs.Conclusions. The inpatient regimen used to treat patients with CHF is more in line with the clinical guidelines.

HYPERTENSION AND ANTIHYPERTENSIVE THERAPY IMPAIR RESPIRATORY FUNCTION

Objective: Tight relationship between respiratory and vascular system appear obvious and several studies showed an association between lung function and hypertension. Furthermore, antihypertensive treatment itself might have an effect on lung function. Thus, the aim of this study was to determine association of hypertension and its treatment with respiratory function. Design and method: In order to evaluate the respiratory system functional state in hypertensive patients we studied 107 patients (mean 49,5±2,7 years old) with mild (1st group), moderate (2nd group) essential hypertension (EH) and neurocirculatory hypertensive asthenia (3d group), for control we observed 30 healthy subjects (4th group). Furthermore, stratification of treatment non-compliant and compliant patients was made to observe the possible impact of antihypertensive treatment. All patients had no chronic respiratory disease in anamnesis and were randomized dependently from the blood pressure levels. Parameters of the respiratory system function were examined by computer spirography. Results: Such predictive and active parameters of computer spirography as Maximum Voluntary Ventilation (MVV), Forced Vital Capacity (FVC), Forced Expiratory Volume after 1s (FEV1), FEV1 as % of Inspiratory Vital Capacity (FEV1%VCIN), FEV1 as % of FVC (FEV1E), and Peak Inspiratory Flow (PIF) did not significantly differ between 1st, 3d and 4th observed groups. But in the 1st and a little bit less in the 3d groups data of active parameters mentioned above were insignificantly lower (p>0.05) compared to healthy individuals. In the 2nd group patients MVV, FEV1%VCIN, FEV1E were uncertainly lower (p>0.05) than in the 1st and 3d groups, but were still border-normal with tendency to forming combined respiratory and heart failure. Antihypertensive treatment was associated with a deterioration in FEV1 by -150.3±12.78 ml (p = 0.01) and in FVC by -190.2±20.05 ml (p<0.01). With both high blood pressure and antihypertensive medication as individual variables in one regression model, only medication decreased FEV1 and FVC statistically significantly (p<0.01). Conclusions: Thus, a tendency for aggravation of the active parameters of respiratory function in patients with arterial hypertension is dependent on the blood pressure levels and use of antihypertensive medications.

Clinical, laboratory and instrumental predictors of the effectiveness of anti-inflammatory therapy in COVID-19

BACKGROUND: Anti-inflammatory therapy is a leading method of pathogenetic treatment of moderate and severe forms of COVID-19. The drugs used during anti-inflammatory therapy, in particular, dexamethasone, olokizumab, tocilizumab, and baricitinib, are still actually prescribed in off-label mode. Of course, their use is justified by the Russian and international clinical guidelines, practical experience, expert opinions. However, the opinion of an attending physician, based on the assessment of the risk/benefit ratio for each patient, is fundamental in determining a drug for anti-inflammatory therapy. Determination of clinical and laboratory predictors of anti-inflammatory therapy effectiveness in moderate and severe forms of COVID-19 will facilitate a decision-making process when identifying risk groups for developing an adverse outcome during anti-inflammatory therapy, as well as determining an optimal drug for an anti-inflammatory therapy, taking into account the identified criteria.
 AIM: To compare the effectiveness of preemptive anti-inflammatory therapy with anticytokine drugs (tocilizumab, olokizumab, baricitinib, dexamethasone) in the patients with moderate and severe COVID-19 to identify clinical, laboratory and instrumental predictors of anti-inflammatory therapy outcome.
 MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate COVID-19 disease requiring various types of anti-inflammatory therapy at the Hospital of War Veterans, including the Lenexpo site.
 RESULTS: The study has identified the main (significantly affecting the outcome) and additional (significant) predictors of the effectiveness of anti-inflammatory therapy in moderate and severe forms of COVID-19. The main ones include: the level of oxygen support, the period from the onset of clinical manifestations, the level of C-reactive protein, D-dimer. The additional, but significant factors include: the amount of damage to the lung tissue according to the computed tomography data, the presence and degree of compensation of concomitant pathology, the presence of therapy for concomitant pathology, as well as the level of leukocytes and neutrophils in the clinical blood test.
 CONCLUSIONS: The presence of additional oxygen support is a leading predictor of the effectiveness of an anti-inflammatory therapy, and its administration as early as possible, if indicated, can significantly increase the chances of a favorable outcome for a patient with moderate to severe COVID-19. Important prognostic markers also include C-reactive protein and D-dimer. The presence of concomitant diseases in anamnesis, as well as the degree of lung damage according to computer tomography data, are significant factors; however, they should be compared with other clinical and laboratory data and the objective status of the patient in order to predict the outcome of an anti-inflammatory therapy.

Prostaglandins in ophthalmology

Prostaglandins are widely used in medicine as active physiological agents that form a new class of drugs for treatment of cardiovascular diseases, some forms of bronchial asthma, as well as in gynecology and ophthalmology. Development of aseptic inflammation is an example of intracellular process, in which the produced prostaglandins are able to and do cause vasodilatation, increased vascular permeability, pain and fever. These effects of prostaglandins and leukotrienes characterize the classic picture of inflammation, including the aseptic one. The use of non-steroidal anti-inflammatory drugs (NSAIDs) can provide therapeutic effect via inhibition of prostaglandin secretion. Prostaglandins play a special role in glaucoma treatment. Prostaglandin analogues are powerful agents that decrease IOP by 20-40% with a unique mechanism of action. Prostaglandin analogues have a well-balanced safety profile, which is why they are considered as a first line of therapy. However, patients with inflammatory diseases in anamnesis, such as uveitis, herpes, keratitis, as well as patients with planned cataract extraction should be careful when using prostaglandin analogues.

Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up

BackgroundLong-term effects of Coronavirus Disease of 2019 (COVID-19) and their sustainability are of the utmost relevance. For the chronic phase, the main concerns are the development of pulmonary interstitial disease and/or lingering cardiovascular involvement. How to intercept, assess, and treat these patients with long-term consequences of COVID-19 remains uncertain.PurposeWe aimed to determine: 1) functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) those characteristics associated with CPET performance; 3) safety and tolerability of CPET.MethodsWe prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 discharged alive at a single hospital in northern Italy. At 3-month from hospital discharge, complete clinical evaluation, trans-thoracic echocardiography, cardiopulmonary exercise testing (CPET), pulmonary function test (PFT), and dominant leg extension (DLE) maximal strength evaluation were performed.ResultsFrom 225 patients discharged from March to November 2020 we excluded 12 incomplete/missing cases, and 13 unable to perform CPET leading to a final population of 200 patients. At PFT all median parameters were within normality range.Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3–103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value (indicating normality).Sixteen (16.2%) patients had respiratory, 28 (28.9%) cardiac, 21 (21.2%) mixed-cardiopulmonary, and 34 (34.3%) non-cardiopulmonary limitation of exercise. One-hundred sixty (80.0%) patients complain at least one symptom, without relationship with peakVO2.Multivariate linear regression analysis showed percent-predicted forced expiratory volume in one-second (β=5.29, p=0.023), percent-predicted diffusing capacity of lungs for carbon monoxide (β=6.31, p=0.001), and DLE maximal strength (β=14.09, p=0.008) independently associated with peakVO2.At sensitivity analysis, the results of previous multivariate linear regression analysis were also similar among sub-groups of patients with no previous significant disease in anamnesis (cardiovascular disease except for arterial hypertension, respiratory disease, kidney disease, or cancer) and of those with a length of hospital stay ≤7 days.None major event was reported during/after CPET, whereas only two cases (1.0%) had a mild symptomatic hypotension post exercise. None of the involved health professionals developed COVID-19.ConclusionsCPET after COVID-19 is safe and about 1/3rd of COVID-19 survivors show functional capacity limitation mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.Funding AcknowledgementType of funding sources: None. Types of mainly CPET limitationPeak VO2 per leg extension strength

Relationship between transient symptomatic hypotensive episodes and 24-hour blood pressure variability in patients with arterial hypertension

Abstract Purpose Low blood pressure may be as harmful as high. Symptomatic hypotensive episodes should be a manifestation of circulatory disorders of hypertension – mediated organs especially among hypertensive patients. However, the association of such episodes with blood pressure variability is unknown. Aim To study the relationship between the symptomatic hypotensive episodes and the daily blood pressure variability according to the ambulatory blood pressure monitoring (ABPM) in patients with hypertension. Materials and methods 106 patients aged between 40 and 65 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. Daily blood pressure variability was defined as standard deviation. Results Among all patients, symptomatic hypotensive episodes were observed in 60.6%. Among patients without myocardial infarction or stroke in anamnesis - 52.4%, with ones - 75% participants (p=0.05). Among patient without myocardial infarction or stroke and with symptomatic hypotensive episodes, the high variability of daily systolic BP was observed in 36% of the subjects and averaged 14.3 mm Hg, in the absence of symptomatic hypotensive episodes, the variability of daily systolic BP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p<0.05). In case of stroke or myocardial infarction in anamnesis and the presence of symptomatic hypotensive episodes, the systolic BP variability of daytime (18.0 mm Hg) and nighttime (14.8 mm Hg) was the highest. The proportion of participants with daily systolic BP variability exceeding the norm was 78%. In the absence of symptomatic hypotensive episodes, the blood pressure variability indicators did not deviate from the norm (p<0.05). Conclusion Heart attack and/or stroke in anamnesis with symptomatic hypotensive episodes are associated with lower daily systolic BP variability (14.3 mm Hg) in comparison with patients without symptomatic hypotensive episodes (16.3 mm Hg). If there were stroke or myocardial infarction in anamnesis, patients with symptomatic hypotensive episodes have higher daily systolic BP variability (18.0 mm Hg) than without hypotensive episodes (14.5 mm Hg). Symptomatic hypotensive episodes are not unidirectionally associated with the variability of blood pressure, the character of the relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis. Funding Acknowledgement Type of funding sources: None.

Features of the clinical course of ischemic stroke in postcovid patients

Background and aims: The study of the course of the disease in patients previously ill with COVID-19 infection would contribute to adjusting approaches to the treatment of such patients in order to improve the efficiency of the cure. Methods: We observed 45 patients previously ill with COVID-19 and admitted with a diagnosis of ischemic stroke and apply the Sf-36, MOCA, HADS, Rivermide, Rankin and NIHHS scales, of these, 44.4% (20) were women, and 55.6% (25) were men. The average age of patients was 61.2 (52–74) years. The control group of patients, also with ischemic stroke, but without Covid-19 disease in anamnesis, also consisted of 45 people, 48.9% (22) were women and 51.1% (23) were men. The average age of patients was 62.8 (53–78) years. Results: In 42 patients previously ill with COVID-19, significant results of the studied indicators indicating a more severe course of the disease were observed compared to those in the control group. At the same time, no significant differences were observed among men and women. In the group of patients who had not previously suffered from COVID-19, only 6patients (13.3%) also suffered from the disease. The majority of these patients were men aged 63 and above. Conclusions: The results of the studies indicate a strong influence of the fact of the previously suffered infection COVID-19 on the nature and duration of the course of ischemic stroke. A history of COVID-19 should contribute to the revision of treatment tactics and the intensity of interventions and be prepared for a longer process of rehabilitation procedures.

Вікові особливості перебігу функціональних розладів біліарного тракту в дітей

Актуальність. Функціональні розлади біліарного тракту залишаються поширеною патологією в дітей різного віку. Основними проявами функціональних розладів біліарного тракту в дітей є прояви диспептичного, больового, астеновегетативного та холестатичного синдромів різного ступеня вираженості. Мета дослідження: вивчити особливості проявів функціональних розладів біліарного тракту в дітей різних вікових груп. Матеріали та методи. Під спостереженням перебувало 85 дітей віком від 3 до 17 років із підтвердженим діагнозом функціональних розладів біліарного тракту. Обстеження хворих включало: анамнестичні дані, загальноклінічне обстеження, лабораторні та інструментальні дослідження. Серед обстежених дітей 44 дитини були віком від 3 до 6 років, 41 хворий — від 7 до 17 років. Результати дослідження. Головними причинами захворювання серед дітей дошкільного віку були нераціональне харчування (63,6 %), перенесені гострі інфекції травної системи (29,5 %), наявність вогнищ хронічної інфекції (22,7 %). За результатами аналізу клінічних проявів виявлено, що у 88,6 % дітей дошкільного віку переважали прояви гіпокінетичної форми функціональних розладів біліарного тракту з постійним неінтенсивним болем у животі та диспептичним синдромом. Головними причинами загострення перебігу захворювання серед школярів були нераціональне харчування (92,6 %), психоемоційне навантаження (43,9 %), гіподинамія (34,2 %), дискоординація вегетативної регуляції організму (24,3 %). У 48,7 % дітей шкільного віку діагностовано панкреатичні розлади. Обговорення результатів. Терапевтичну корекцію функціональних розладів біліарного тракту в дітей треба проводити з урахуванням того, що в дітей дошкільного віку переважали прояви гіпокінетичної форми функціональних розладів біліарного тракту, а в шкільному віці частіше діагностовані функціональний панкреатичний розлад сфінктера Одді та функціональний біліарний розлад сфінктера Одді гіперкінетичної форми. Висновки. Урахування вікових особливостей перебігу функціональних розладів біліарного тракту в дітей сприятиме вибору оптимальної схеми терапії для поліпшення стану дитини.

The medical demographic and social characteristics of women that discontinued observation and infertility treatment

The recovering of reproductive health of women is one of prospective means to stabilize fertility. The purpose of the study is to investigate medical, demographic and social risk factors of discontinuing screening and treatment of infertility in women of the Tambov Oblast. The materials and methods. The comparative data analysis of women who discontinued infertility screening and treatment prior to referral to auxiliary reproductive technologies (n = 239) and women who were factually referred to these technologies (n = 206). The results of the study. The risk factors for women of discontinuing screening and treatment of infertility included age (OR = 1.070; 95% CI 1,035-1,105; p<0.001), residence in rural areas (OR = 2.059; 95% CI 1.592-2.663; p<0.001), secondary education (OR = 2.593; 95% CI 1.767-3.805; p<0.01), low level of financial security (OR = 2.524; 95% CI 1,720-3,703; p<0.01), secondary nature of infertility (OR = 1.587; 95% CI 1.065-2.364; p=0.023), occurrence of sexually transmitted diseases in anamnesis (OR = 2.736; 95% CI 1,722-4,346; p<0.01). Discussion. The study results demonstrate that the most effective measures improving compliance of women to screening and treatment of infertility are the reorientation of medical care to the second-level regional centers from the regional center that will bring medical care, including active detection of infertility at younger age, more comprehensive regular preventive examinations and health education to preserve reproductive health, closer to remote areas. The conclusions. The medical, demographic and social risk factors of discontinuing testing and treatment of infertility in women are established to be applied in improving the organization of medical care for this category of patients.

New prognostic markers of hearing impairment in children: gene-gene interaction and approximation models

Objective: to evaluate the gene-gene interaction, assess the risks and develop some approximation models of hearing loss / deafness occurrence in children, depending on the genes polymorphism gab junction B2 (GJB2, rs80338939), and interleukin-4 (IL-4, rs 2243250) and other risk factors. Materials and methods: Study included 102 children with hearing impairment: 68 with sensorineural (SNHL) and 34 with conductive hearing loss (CHL), among them 36 (35.29%) girls and 66 (64.71%) boys. The patients' age vary from 8 to 18 yo (on the average 13.90±3.11 yo). Diagnosis set by otorhinolaryngology (ENT) methods: ENT examination, computer audiometry, impedancemetry, tympanometry. The control group included 60 practically healthy children: 22 girls (36.67%), 38 boys (63.33%). Polymorphism of GJB2 (rs80338939) and IL-4 (rs 2243250) genes was studied by polymerase chain reaction method. Risk assessed by Relative Risk, Odds Ratio and 95% Confidential intervals.Results. The combination of 35delG / TT, as well as Non-Del / TT and 35delG/ TC genotypes in the genome is associated with a high risk of hearing loss in general children population (from 0.932 to 1.432; OR=19.5; p=0.003), as well as the appearance SNHL (from 0.765 to 1.765), stronger than the combination of unfavorable homozygotes TT / 35DelG - 1.765. The combination of homozygotes for the wild allele of both genes (especially CC / Non-Del) is associated with a low risk of deafness: hearing loss in general -1,068, for SNHL -0,908, for CHL -0,750 (p&lt;0,01), for CC / 35delG combination, or TC / Non-Del: in general -0.068 -, and for SNHL -0.235 and -0.11 respectively, (p&gt;0.05).Infectious diseases in anamnesis (meningitis, measles, mumps, or rubella) increases the likelihood of CHL by 9.41 times (OR=12.0; p=0.007). Concomitant chronic non-obstructive and obstructive upper and lower respiratory tract diseases increase the risk of both SNHL and CHL in children regardless of age: for SNHL 3.75-7.81 times (OR=6.50-10.9; p≤0.028-0.01), for CHL – 4.29-8.75 times (OR=6.19-12.9; p≤0.03-0.009). The revealed dependence of the indicators is best described by the logit-regression approximating models with high multiple correlation coefficient (R2=0.9761); low standard error of the model estimation (ε=0.1114); connection criterion F=124.2; degrees of freedom df=7.43 (p&lt;0.001).Conclusions: Genes polymorphism's GJB2 (rs80338939) and IL-4 (rs 2243250) and their interactions are new prognostic markers of hearing impairment in children. Approximating models describe the likelihood of SNHL and CHL in observed population.

Стихийные бедствия и угрожающие жизни заболевания: психологические последствия и особенности совладания

The article presents the results of the theoretical and empirical study of the psychological consequences of the different types of stressors impact on humans. A frequency analysis of extreme stressful events was carried out on the sample n=529 people (from 17 to 41 years old, 233 men and 296 women). In order to study the psychological consequences of certain types of stressors – natural disasters and life-threatening diseases influence, an analysis of post-traumatic stress and psychopathological symptoms was carried out in the part of the sample (n=90 people). The k-means cluster analysis divided the sample into three groups, the first of which included mainly respondents who indicated life-threatening diseases, and the third one – natural disasters; in the second group, events were distributed evenly. Comparison of different groups data allowed us to verify the hypothesis of the study. Revealed that the psychological consequences of natural disasters and life-threatening diseases differ in the level of post-traumatic stress and psychopathological symptoms – depression, anxiety, interpersonal sensitivity, paranoia and other symptoms, which are more pronounced in people with a severe somatic disease in anamnesis. The success of coping with psychological consequences of the various stressors influence is analyzed in the context of interpreting these consequences as a collective or individual trauma.

The risk factors of depression in patients with type 2 Diabetes Mellitus

The results of prospective international research for risk factors determining of depression and assessing their impact on life in patients with type 2 Diabetes Mellitus (DM) were described in this article. Aims: To study risk factors of depression in patients with type 2 DM, based on results of conduc ted research. Materials and me thods: accor ding to study requi rements of international research INTERPRET-DD (International Prevalence and Treat ment of Diabetes and Depres sion), 190 pa tients diff erent sex were rando mized. Adapted scales PHQ-9, PAID, WHO, MINI-6, Hamilton Score were used as materials for depression diagnostic; processed data from patients Medical History for the last 15 years, anamnesis, physical examination, consulting by psychiatrist, endocrinologist, podiatrist, HbA1C and Lipid profi le measu ring. The work consisted of tandem collaboration between a psychiat rist and an endocrinologist, who monitored randomized patients for one year, and also determined the tactics of diagnosis, treatment, and the development of preventive measures. According to received results, the follow risk factors of depression in patients with type 2 DM were frequent episodes of hypohyperglycemia, high level of concomitant diseases in anamnesis, patient’s age, low education level, job absence, unstable family income, family status, presence of depression in family anamnesis. Key words: diabetes mellitus, depression, depression factors, antidepressant

Systemic inflammation and immunological microenvironment in prognosis of solid tumors

The purpose of the research. To study prognostic significance of indicators of systemic inflammation of peripheral blood and relative indicators: neutrophil‑lymphocytic and platelet‑lymphocytic ratio, the course of squamous cell carcinoma of the oral mucosa and gastric adenocarcinoma.Materials and methods. Prospective analysis of patients with squamous cell carcinoma of the oral mucosa and disseminated gastric adenocarcinoma was performed. Patients with verified diagnosis, without signs of inflammatory diseases in anamnesis, not receiving antibacterial and immunomodulatory therapy were selected. Overall survival and survival without progression were considered as the main estimated parameters.Results. The selection criteria were met by 32 patients with disseminated gastric adenocarcinoma and 60 patients with squamous cell carcinoma of the oral mucosa. The prognostic value of relative indicators is determined: overall survival of patients with gastric adenocarcinoma with a low value of the neutrophil‑lymphocytic index is significantly higher than that of the rest of the cohort of patients: 16 months vs. 8 and 7 months (95 % CI (confidence interval) from 12 to 23 months, p=0.0382). Overall survival of patients with low platelet‑lymphocytic index was also higher: 16 months vs. 8 months (95 % CI from 11 to 24 months, р=0,0026). Different relapse‑free survival was noted in the group of patients with squamous cell head and neck cancer: patients with low index value it is 7 months vs. 2 months (95 % CI from 5 to 9 months, p=0.0499).Conclusions. The results show the possibility of using immunological microenvironment of the tumor and indices, characterizing the systemic inflammation, for prognosis of gastric adenocarcinoma and squamous cell carcinoma of the oral mucosa.

Trichoscopic Findings in Normal Hair and Scalp in Children Under 17 Years.

Objective:The aim of the study is to establish normal values of measurable parameters, set the standard, and provide a framework for future reference.Materials and Methods:A total of 750 children of Malayalam speaking ethnicity with no hair or scalp diseases in anamnesis and clinical examination were included in the study. Children were divided into six age groups (neonates, infants, 1–5, 6–10, 11–14, and 15–17 years), and trichoscopy was performed in frontal, left and right temporal, vertex, crown, and occiput using Wi-Fi cordless digital dermoscope. Hair shaft, follicular opening, and perifollicular and interfollicular area were evaluated and analyzed with SPSS software.Results:Among the parameters analyzed, we observed that with 0.95 probability (95%), the terminal: vellus ratios are (26,29), (22,25), (22,26), (29,33), (25,29), and (19,24) in neonates; (11,14), (7,11), (9,13), (13,17), (12,16), and (7,12) in infants; (16,17), (10,11), (10,11), (16,18), (15,16), and (14,15) in 1–5 years; (17,18), (11), (11), (19,21), (23), and (16,17) in 6–10 years; (17,18), (9,10), (10), (19,20), (18,19), and (16,17) in 11–14 years; and (14,15), (8–9), (8,9), (15,16), (14, 16), and (13,14) in 15–17 years. Likewise, we have documented the various trichoscopic findings of different age groups.Conclusion:We propose the summary of trichoscopic patterns of different age groups with normal hair and scalp to accurately identify the abnormal.

What factors do influence arterial hypertension control in Russia

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients. Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data. Material and methods . Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio. Results . Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p<0,001) and OR=1,47 (p<0,0001), respectively, as in women — OR=1,41 (p<0,003) and OR=1,62 (p<0,0001). Group two is characterized by higher level of the risk factors, and complete model of logistic regression has revealed positive associations of high HR, general obesity, high triglycerides and glucose with ineffective treatment in males; in females — high HR, general obesity. Conclusion. It is necessary to apply various approaches to increase the number of persons with controlled BP. Broad informing on healthy lifestyle, incl. target BP levels in those who do not visit physician office. Screening in AH is necessary, esp. for antihypertensive medication intake control.

Репродуктивний анамнез жінок із післяпологовими гнійно-септичними ускладненнями

Postpartum purulent-septic complications are considered to be one of the main causes of maternal loss, hence, this is why they continue to maintain their relevance and priority in modern obstetrics. The incidence of this disease remains high and aggravates the extension of the postpartum period in 5–26% of cases. Mostly postpartum purulent-septic complications are caused by not one, but a combination of several reasons that can act simultaneously or sequentially and are often caused by a combination of medical and social factors. These factors require the necessity of diligent analysis of the reproductive anamnesis of women who suffered from complications of septic nature during the postpartum period, in order to highlight the risk factors for these complications. The objective: to explore the possibility of formation of high-risk groups based on the analysis of reproductive anamnesis in women with postpartum purulent-septic complications as part of preventive measures. Patients and methods. According to the purpose of this research a detailed retrospective analysis was made of anamnesis histories of 89 women (study group) with postpartum septic complications, namely, 58 women with postpartum purulent-septic complications who bore through natural birth canal; 31 women with postpartum purulent-septic complications after cesarean section. The control group consisted of 40 women recently confined within uncomplicated maternal postpartum process. Results. It was investigated that in the group of women with postpartum complications prevailed women who were pregnant for the second time (especially after cesarean section).It is important to highlight the fact that significant percentage of menstrual disorders and the commencement of early sexual live of women in the study group. Analysis of an illness revealed a significant incidence of inflammatory diseases of the female reproductive organs, cervical pathology, chronic tonsillitis, chronic pyelonephritis, cystitis, anemia clinical history in the main group. Significant percentage is noticed of the women with thyroid disorders. Significantly higher frequency was noticed with regards to pregnancies that had negative consequences in anamnesis, the presence of gynecological pathology, surgery and vaginal microbiota disturbances before and during pregnancy in women with postpartum purulent-septic complications. A combination of two or more selected factors, especially in women with extragenital pathology and transferred infectious diseases in anamnesis, greatly increases the risk of septic complications in the postpartum period. Conclusions. Current analysis has provided implicit evidences to ensure that it is important to select a separate group at high risk of postpartum septic complications on the stage which precedes pregnancy for the development of an individual plan for diagnostic and preventive measures to prevent this disease. Key words: postpartum purulent-septic complications, risk factors, reproductive anamnesis.

Efficiency of auxiliary reproductive technologies in the case of women having gynecological and extragenital inflammatory diseases in anamnesis

Efficiency of auxiliary reproductive technologies in the case of women having gynecological and extragenital inflammatory diseases in anamnesis